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What is Immunotherapy/Vaccine Treatment for Prostate Cancer?

What is immunotherapy and how does it help fight prostate cancer?

Normally, the body’s immune system, including white blood cells, fight disease and infection. These cells, including T-cells, recognize foreign infectious particles, as well as damaged or diseased cells, and destroy them. This process is what allows our body to be exposed to so many germs on a daily basis and, in most cases, not get seriously ill.

Cancer cells are not foreign invaders nor healthy cells. They are cells native to our bodies that have mutated. These mutations allow for cancer cells to evade our immune system’s damage and growth checkpoints to create tumors. Cancer cells have the ability to evade the body’s natural immune response system under the disguise of being a normal, native cell. Immunotherapies as they relate to cancer, are treatments that aim to train the natural immune response into identifying and attacking cancerous cells. Examples of cancer immunotherapies include vaccines, cytokines, and checkpoint inhibitors. There is currently one cancer vaccine on the market indicated for prostate cancer, however, many other immunotherapy options, including additional vaccines, are being researched.1,2

Sipuleucel-T (Provenge)

Provenge is the only cancer vaccine approved by the FDA for prostate cancer. Specifically, the vaccine is indicated for use by individuals with metastatic castrate resistant prostate cancer that presents with few to no symptoms. Provenge can be used in individuals who have moderate to severe pain related to their prostate cancer, however, Provenge should not be used by any individual receiving chemotherapy or immunosuppressive agents.

Provenge is made on a case-by-case basis, and is tailored specifically to the individual receiving the vaccination. This is done by extracting a sample of the individual’s white blood cells approximately three days prior to vaccination. These cells are sent to a special lab where they are exposed to a protein called PAP (prostatic acid phosphatase). These cells are then re-inserted into the body via an intravenous (IV) injection, to stimulate the immune system to attack cancer cells that carry this protein (PAP). The vaccine is not intended to cure prostate cancer, however, it has been theorized that it could be an additional life-prolonging option for metastatic prostate cancer that isn’t responding to other treatment options.

The vaccine takes about an hour to completely infuse, and is administered three times. Each dosage of the vaccine is injected two weeks apart. Infusion site reactions are possible during the administration of Provenge, and reactions should be treated immediately. The most common side effects of Provenge include:

  • Fatigue
  • Chills
  • Back or joint pain
  • Headaches
  • Nausea
  • Fever

More severe, but much less common, side effects include hypertension (high blood pressure) or low blood pressure and breathing problems can occur, however, these typically subside after treatment. Pain, swelling or warmth over affected areas in your arm or leg may be a sign of thrombosis and should be reported to your doctor immediately. This is not an exhaustive list of all side effects of Provenge. Consult your provider for any additional concerns or questions.

Research is currently underway to identify other additional vaccines and to further define the long-term efficacy and side effects of Provenge. Other notable studies surround a newer vaccine called PROSTVAC. PROSTVAC uses a modified virus containing prostate-specific antigen (PSA) in hopes the immune system will respond and target prostate cancer cells with high levels of PSA. While the preliminary survival data was promising for PROSTVAC, recent results have shown that PROSTVAC does not improve overall survival compared with placebo for patients with metastatic castration-resistant prostate cancer.3,4,7

Other immunotherapies and current areas of research

Other examples of cancer immunotherapies include checkpoint inhibitors and cytokines. In regard to prostate cancer, most of these treatment options need further study. More research needs to be done in regards to cytokines for prostate cancer, however, examples of checkpoint inhibitor treatments that may be of use for prostate cancer include Keytruda (pembrolizumab) and Opdivo (nivolumab), which both target the PD-1 checkpoint protein, and Yervoy (ipilimumab) which targets the CTLA-4 checkpoint protein. Keytruda was recently granted accelerated approval for the treatment of solid tumors with a specific genetic marker, including prostate cancer.8

These checkpoint proteins are what keep the body from attacking its own cells. Cancer cells are able to manipulate these checkpoints to avoid being attacked. By targeting these checkpoints, researchers are hoping to stimulate the immune system to attack cancer cells. Research is also underway to determine the efficacy, if any, of using these types of immunotherapies in combination with vaccines.5,6

Written by: Casey Hribar | Last reviewed: January 2019
  1. Vaccine Treatment for Prostate Cancer. American Cancer Society. https://www.cancer.org/cancer/prostate-cancer/treating/vaccine-treatment.html. Published March 11, 2016. Accessed September 1, 2017.
  2. Immunotherapy. Cancer Treatment Centers of America. http://www.cancercenter.com/treatments/immunotherapy/. Accessed September 1, 2017.
  3. Provenge Prescribing Information. FDA.gov. https://www.fda.gov/downloads/BiologicsBloodVaccines/CellularGeneTherapyProducts/ApprovedProducts/UCM210031.pdf. Accessed September 1, 2017.
  4. PROSTVAC-VF/TRICOM Vaccine for the Treatment of Metastatic Prostate Cancer After Failing Hormone Therapy. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00078585. Published September 7, 2017. Accessed September 22, 2017.
  5. What’s New in Prostate Cancer Research? American Cancer Society. https://www.cancer.org/cancer/prostate-cancer/about/new-research.html. Published March 11, 2016. Accessed September 1, 2017.
  6. Study Provides Path for New Immunotherapy Approaches to Prostate Cancer. The University of Texas: MD Anderson Cancer Center. https://www.mdanderson.org/newsroom/2017/03/study-provides-path-for-new-immunotherapy-approaches-to-prostate-cancer.html. Published March 27, 2017. Accessed September 1, 2017.
  7. Gulley JL, Borre M, Vogelzang NJ, et al. Results of PROSPECT: A randomized phase 3 trial of PROSTVAC-VF (PRO) in men with asymptomatic or minimally symptomatic metastatic, castration-resistant prostate cancer. J Clin Oncol. 2018: 36, (suppl; abstr 5006). Presented at 2018 ASCO Annual Meeting; June 1-5, 2018; Chicago, IL.
  8. FDA approves first cancer treatment for any solid tumor with a specific genetic feature. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm560167.htm Published May 23, 2017. Accessed on January 4, 2019.